The epidemiology of regular opioid use and its association with mortality: Prospective cohort study of 466 486 UK biobank participants

Gary J Macfarlane; Marcus Beasley; Gareth T Jones; Cathy Stannard

doi:10.1016/j.eclinm.2020.100321

The epidemiology of regular opioid use and its association with mortality: Prospective cohort study of 466 486 UK biobank participants

Gary J Macfarlane, Marcus Beasley, Gareth T Jones, Cathy Stannard

Research output: Contribution to journal › Article › peer-review

27 Citations (Scopus)

9 Downloads (Pure)

Abstract

Background: Opioids have, at most, small benefits for non-cancer pain in the medium and long-term but there is good evidence that they cause harm. The current study describes the characteristics and clinical status of people taking regular opioids in Great Britain and determines whether use is associated with mortality risk.

Methods: An analysis of participants in UK Biobank, a prospective population-based study. At recruitment (2006-10) participants reported medicines which they regularly used in addition to lifestyle and health-related factors. Information was available on deaths until October 2016.

Findings: There were 466 486 participants (54% women) aged 40-69 years and without a prior history of cancer of whom 5.5% were regularly using opioids. Use increased with age-group, was more common in females (6.3% v. 4.6%) and 87% of persons using them reported chronic pain. The highest rates of use (~1 in 9) were in people with low household income, who left school <16 years and lived in areas with high deprivation. Amongst 15,032 people who could not work because of ill-health, 1 in 3 were regularly taking opioids. Regular users reported insomnia (88.7%), a recent major recent life event (57.3%) and were much more likely than non-users to rate their health as poor (RR 5.5, 99% CI (4.9, 6.1)). Those taking weak (4.2% of participants) or strong (1.4%) opioids were more likely to die during follow-up (6.9% and 9.1% respectively v. 3.3% in non-users) an excess which remained after adjustment for demographic, socio-economic, health and lifestyle factors (MRR 1.18 99% CI (1.06, 1.32) and 1.20 99% CI (1.01, 1.43)) respectively.

Interpretation: Regular use of opioids is common in Great Britain, particularly in groups of low socio-economic status. Most users still report chronic pain, poor health generally and are at increased risk of premature death although it is not established that this relationship is causal.

Funding: There were no external sources of funding obtained for the current analyses.

Original language	English
Article number	100321
Number of pages	8
Journal	EClinicalMedicine
Volume	21
Early online date	18 Apr 2020
DOIs	https://doi.org/10.1016/j.eclinm.2020.100321 https://doi.org/10.1016/j.eclinm.2020.100321
Publication status	Published - Apr 2020

Bibliographical note

Acknowledgments
This work did not receive any external sources of funding. Data was supplied by UK Biobank under the terms of application reference number 1144.

Data sharing agreement
On acceptance of a manuscript using UK Biobank data, the authors are required to submit the dataset (including any derived variables) and the analysis programs to UK Biobank. Data are available to researchers by application.

Keywords

Opioids
Pain
Prevalence
Mortality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

EClinical Medicine (Opioids)
© 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Final published version, 363 KBLicence: CC BY-NC-ND

Cite this

@article{848d789082684a5abe40787346d5e635,

title = "The epidemiology of regular opioid use and its association with mortality: Prospective cohort study of 466 486 UK biobank participants",

abstract = "Background: Opioids have, at most, small benefits for non-cancer pain in the medium and long-term but there is good evidence that they cause harm. The current study describes the characteristics and clinical status of people taking regular opioids in Great Britain and determines whether use is associated with mortality risk.Methods: An analysis of participants in UK Biobank, a prospective population-based study. At recruitment (2006-10) participants reported medicines which they regularly used in addition to lifestyle and health-related factors. Information was available on deaths until October 2016.Findings: There were 466 486 participants (54% women) aged 40-69 years and without a prior history of cancer of whom 5.5% were regularly using opioids. Use increased with age-group, was more common in females (6.3% v. 4.6%) and 87% of persons using them reported chronic pain. The highest rates of use (~1 in 9) were in people with low household income, who left school <16 years and lived in areas with high deprivation. Amongst 15,032 people who could not work because of ill-health, 1 in 3 were regularly taking opioids. Regular users reported insomnia (88.7%), a recent major recent life event (57.3%) and were much more likely than non-users to rate their health as poor (RR 5.5, 99% CI (4.9, 6.1)). Those taking weak (4.2% of participants) or strong (1.4%) opioids were more likely to die during follow-up (6.9% and 9.1% respectively v. 3.3% in non-users) an excess which remained after adjustment for demographic, socio-economic, health and lifestyle factors (MRR 1.18 99% CI (1.06, 1.32) and 1.20 99% CI (1.01, 1.43)) respectively.Interpretation: Regular use of opioids is common in Great Britain, particularly in groups of low socio-economic status. Most users still report chronic pain, poor health generally and are at increased risk of premature death although it is not established that this relationship is causal.Funding: There were no external sources of funding obtained for the current analyses.",

keywords = "Opioids, Pain, Prevalence, Mortality",

author = "Macfarlane, {Gary J} and Marcus Beasley and Jones, {Gareth T} and Cathy Stannard",

note = "Acknowledgments This work did not receive any external sources of funding. Data was supplied by UK Biobank under the terms of application reference number 1144. Data sharing agreement On acceptance of a manuscript using UK Biobank data, the authors are required to submit the dataset (including any derived variables) and the analysis programs to UK Biobank. Data are available to researchers by application.",

year = "2020",

month = apr,

doi = "10.1016/j.eclinm.2020.100321",

language = "English",

volume = "21",

journal = "EClinicalMedicine",

issn = "2589-5370",

publisher = "Lancet Publishing Group",

}

TY - JOUR

T1 - The epidemiology of regular opioid use and its association with mortality

T2 - Prospective cohort study of 466 486 UK biobank participants

AU - Macfarlane, Gary J

AU - Beasley, Marcus

AU - Jones, Gareth T

AU - Stannard, Cathy

N1 - Acknowledgments This work did not receive any external sources of funding. Data was supplied by UK Biobank under the terms of application reference number 1144. Data sharing agreement On acceptance of a manuscript using UK Biobank data, the authors are required to submit the dataset (including any derived variables) and the analysis programs to UK Biobank. Data are available to researchers by application.

PY - 2020/4

Y1 - 2020/4

N2 - Background: Opioids have, at most, small benefits for non-cancer pain in the medium and long-term but there is good evidence that they cause harm. The current study describes the characteristics and clinical status of people taking regular opioids in Great Britain and determines whether use is associated with mortality risk.Methods: An analysis of participants in UK Biobank, a prospective population-based study. At recruitment (2006-10) participants reported medicines which they regularly used in addition to lifestyle and health-related factors. Information was available on deaths until October 2016.Findings: There were 466 486 participants (54% women) aged 40-69 years and without a prior history of cancer of whom 5.5% were regularly using opioids. Use increased with age-group, was more common in females (6.3% v. 4.6%) and 87% of persons using them reported chronic pain. The highest rates of use (~1 in 9) were in people with low household income, who left school <16 years and lived in areas with high deprivation. Amongst 15,032 people who could not work because of ill-health, 1 in 3 were regularly taking opioids. Regular users reported insomnia (88.7%), a recent major recent life event (57.3%) and were much more likely than non-users to rate their health as poor (RR 5.5, 99% CI (4.9, 6.1)). Those taking weak (4.2% of participants) or strong (1.4%) opioids were more likely to die during follow-up (6.9% and 9.1% respectively v. 3.3% in non-users) an excess which remained after adjustment for demographic, socio-economic, health and lifestyle factors (MRR 1.18 99% CI (1.06, 1.32) and 1.20 99% CI (1.01, 1.43)) respectively.Interpretation: Regular use of opioids is common in Great Britain, particularly in groups of low socio-economic status. Most users still report chronic pain, poor health generally and are at increased risk of premature death although it is not established that this relationship is causal.Funding: There were no external sources of funding obtained for the current analyses.

AB - Background: Opioids have, at most, small benefits for non-cancer pain in the medium and long-term but there is good evidence that they cause harm. The current study describes the characteristics and clinical status of people taking regular opioids in Great Britain and determines whether use is associated with mortality risk.Methods: An analysis of participants in UK Biobank, a prospective population-based study. At recruitment (2006-10) participants reported medicines which they regularly used in addition to lifestyle and health-related factors. Information was available on deaths until October 2016.Findings: There were 466 486 participants (54% women) aged 40-69 years and without a prior history of cancer of whom 5.5% were regularly using opioids. Use increased with age-group, was more common in females (6.3% v. 4.6%) and 87% of persons using them reported chronic pain. The highest rates of use (~1 in 9) were in people with low household income, who left school <16 years and lived in areas with high deprivation. Amongst 15,032 people who could not work because of ill-health, 1 in 3 were regularly taking opioids. Regular users reported insomnia (88.7%), a recent major recent life event (57.3%) and were much more likely than non-users to rate their health as poor (RR 5.5, 99% CI (4.9, 6.1)). Those taking weak (4.2% of participants) or strong (1.4%) opioids were more likely to die during follow-up (6.9% and 9.1% respectively v. 3.3% in non-users) an excess which remained after adjustment for demographic, socio-economic, health and lifestyle factors (MRR 1.18 99% CI (1.06, 1.32) and 1.20 99% CI (1.01, 1.43)) respectively.Interpretation: Regular use of opioids is common in Great Britain, particularly in groups of low socio-economic status. Most users still report chronic pain, poor health generally and are at increased risk of premature death although it is not established that this relationship is causal.Funding: There were no external sources of funding obtained for the current analyses.

KW - Opioids

KW - Pain

KW - Prevalence

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=85083327470&partnerID=8YFLogxK

U2 - 10.1016/j.eclinm.2020.100321

DO - 10.1016/j.eclinm.2020.100321

M3 - Article

C2 - 32322808

SN - 2589-5370

VL - 21

JO - EClinicalMedicine

JF - EClinicalMedicine

M1 - 100321

ER -

The epidemiology of regular opioid use and its association with mortality: Prospective cohort study of 466 486 UK biobank participants

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Gary Macfarlane

Cite this

The epidemiology of regular opioid use and its association with mortality: Prospective cohort study of 466 486 UK biobank participants

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Profiles

Gary Macfarlane

Cite this